College of Medicine & Public Health, Flinders University Rural Health SA, Flinders University, Adelaide, South Australia, Australia.
Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia.
PLoS One. 2020 May 21;15(5):e0233450. doi: 10.1371/journal.pone.0233450. eCollection 2020.
Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive.
个性化的老年护理方法可改善痴呆症护理质量，还能让护理人员了解痴呆症患者的疾病进程和独特护理需求。个性化的护理模式对养老院的整体组织文化会产生重大影响。然而，与痴呆症相关的个性化老年护理维度通常管理不善。我们旨在使用混合方法“Harmony in the Bush”痴呆症研究的定性数据，探索塑造农村养老院个性化痴呆症护理维度的因素。研究参与者包括昆士兰州和南澳大利亚州五家农村养老院的临床经理、注册护士、注册护师和护理人员。104 名员工参加了三个阶段的 65 次半结构化访谈和 20 次焦点小组：干预后、一个月随访和三个月随访。伦茨等人（1998 年）开发的养老院护理质量多维模型用于对数据进行编码和分析因素。研究结果中出现了三个关键主题，包括七个维度：居民和家庭[居民和家庭为中心以及评估和护理计划]；员工[员工教育和培训、员工与居民互动和工作生活平衡]；以及组织[领导力和组织文化以及物理环境和安全]。管理层和员工没有充分考虑家庭成员的意见，整体护理计划整合度差，资源有限，员工缺乏持续教育，导致个性化痴呆症护理实施效果不佳。了解这些维度和相关因素可能有助于解释痴呆症护理个性化方法的多维方面。对员工进行以患者为中心的方法、评估和计划方面的培训，以及在员工之间和员工与居民之间建立关系，对于提高居民所接受的护理质量至关重要。
